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General NPI Number Information
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NPI Number | 1891876819
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Entity Type | Individual
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Provider Name | STEPHEN C SMITH M.A., PSY.D.
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Gender | Male
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Dates
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Enumeration Date | 10/17/2006
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Last Update Date | 03/17/2018
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Provider Practice Location Address
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Address Line | 2035 E STONEBROOK PL
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City | KINGSPORT
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State | TN
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Zip | 37660-4000
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Country | US
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Telephone | 423-282-1480
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Fax | 423-928-1353
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Provider Business Mailing Address
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Address Line | PO BOX 4018
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City | JOHNSON CITY
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State | TN
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Zip | 37602-4018
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Country | US
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Telephone | 423-282-1480
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Fax | 423-928-1353
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 2783
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License Number State | TN
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